Re: Spasm of the digital vessels after accidental Epipen release                     – A simple solution to a potentially increasing                 problem

Ismail, Y.; Juma, Ali

doi:10.1177/1753193408087103

Cited by 7 publications

(3 citation statements)

References 4 publications

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“…This is accepted by the plastic surgery community and identified in the emergency medicine literature [ 17 , 18 ]. Paresthesia is the most commonly reported adverse reaction to digital epinephrine, and this generally resolves in less than six months [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Subcutaneous injection of phentolamine or terbutaline is included in traditional treatment options. These reversal agents are considered good alternatives if necrosis, with symptoms showing no timely resolution, has been identified [ 19 , 21 ]. Two topical vasodilators, topical calcium channel blockers and topical nitroglycerin, are considered alternative, less invasive treatment methods.…”

Section: Discussionmentioning

confidence: 99%

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Reversal of Digital Ischemia with Phentolamine After Accidental Epinephrine Injection

2020

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Patient: Female, 26-year-old Final Diagnosis: Digital ischemia secondary to accidental epinephrine injection Symptoms: Pain Medication: — Clinical Procedure: Local injection of phentolamine to reverse ischemia Specialty: Plastic Surgery Objective: Management of emergency care Background: Accidental finger-stick injuries have been reported with epinephrine autoinjectors, such as EpiPen and EpiPen Jr, and can result in necrosis and digital ischemia. However, long-term adverse effects are very rare. The treatment for accidental finger-stick injuries is controversial and includes intra-arterial injections of vasodilating agents, topical vasodilators, and supportive management as needed. Case Report: Here, we report a case of a 26-year-old pharmacist who injected herself accidentally with an EpiPen on the tip of her index finger. Warm water and nitroglycerine gel did not alleviate her symptoms. After three hours, phentolamine was injected around the necrotic area, and the skin normalized. Conclusions: All health professionals should be trained in how to handle epinephrine autoinjectors safely. Phentolamine may be efficacious in treating accidental finger-stick injuries from epinephrine autoinjectors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reversal of Digital Ischemia with Phentolamine After Accidental Epinephrine Injection

2020

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“…Historical treatments included subcutaneous injection of phentolamine (an alpha receptor antagonist) or terbutaline (a beta receptor agonist). Although rarely used, these reversal agents continue to be good alternatives if resolution of symptoms does not improve in a timely period and necrosis is suspected [7,8]. Less invasive methods include topical vasodilators, including topical nitroglycerin and a topical calcium channel blocker, both have been used but little data to demonstrate efficacy.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Epinephrine Auto-injector Accident Without Digital Ischemia

Shapiro¹,

Ziehl²

2019

Cureus

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Accidental finger sticks with EpiPens and EpiPen Jr (epinephrine auto-injectors) are a very real hazard in those who carry them and their families. The most feared complications are digital ischemia and necrosis; however, long-term adverse effects are extremely rare. Treatment for a finger stick is controversial, ranging from intra-arterial injections of vasodilating agents to topical vasodilators to conservative management. We report a pediatric patient suffering from an EpiPen Jr accidental stick to the distal first digit who was successfully managed in a conservative fashion.

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Summary and simulation of reported adverse events from epinephrine autoinjectors and a review of the literature

Shaker

Toy

Lindholm

et al. 2018

The Journal of Allergy and Clinical Immunology: In Practice

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Re: Spasm of the digital vessels after accidental Epipen release – A simple solution to a potentially increasing problem

Cited by 7 publications

References 4 publications

Reversal of Digital Ischemia with Phentolamine After Accidental Epinephrine Injection

Reversal of Digital Ischemia with Phentolamine After Accidental Epinephrine Injection

Pediatric Epinephrine Auto-injector Accident Without Digital Ischemia

Summary and simulation of reported adverse events from epinephrine autoinjectors and a review of the literature

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